{"id":797,"title":"BURGLARY INSURANCE POLICY (RETAIL) Claim Form","purpose":"claim","insurer":{"slug":"magma-general-insurance","name":"Magma General Insurance Limited"},"source_pdf":"https://www.magmainsurance.com/documents/5553002/5571036/Claim+Form+%E2%80%93+Burglary+Insurance+Policy.pdf/992e4f63-9b62-811d-e9d2-a5a16b15a86c?t=1789042999489","sha256":"f368e83716d0f37b47708d5f4985516d90fc0fd58e5300afcf3e2225d5b5ef83","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person to claim for loss or damage under the Burglary Insurance Policy (Retail). The policyholder or insured fills it.","notes":["All questions must be answered fully; use separate sheet if needed and attach.","Incomplete or blank sections will cause the form to be returned for completion.","The issue or acceptance of this form is not an admission of liability by the insurer.","The amount claimed should exclude any profit and add-on cover amounts should be indicated separately."],"title":"BURGLARY INSURANCE POLICY (RETAIL) Claim Form","submit":{"to":"Company/Surveyor immediately","how":"return this form immediately","address":""},"purpose":"claim","sections":[{"title":"A. The Insured","fields":[{"help":"","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Tel No. Office","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"email","options":[],"required":false,"pdf_field":""},{"help":"Alternate contact person","type":"text","label":"Contact name","options":[],"required":false,"pdf_field":""},{"help":"Contact person's mobile","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"Contact person's email","type":"email","label":"email","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"B. Policy Details","fields":[{"help":"Policy number as per your documents","type":"text","label":"Policy No.","options":[],"required":true,"pdf_field":""},{"help":"Start date of policy period","type":"date","label":"Period of Insurance : From","options":[],"required":true,"pdf_field":""},{"help":"End date of policy period","type":"date","label":"to","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"C. Loss Details","fields":[{"help":"Date of loss","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Time of loss with am/pm","type":"text","label":"Time","options":["am","pm"],"required":true,"pdf_field":""},{"help":"When the loss was discovered","type":"text","label":"Date/Time Discovered","options":[],"required":true,"pdf_field":""},{"help":"Person who discovered the loss","type":"text","label":"By whom","options":[],"required":true,"pdf_field":""},{"help":"Full address where loss occurred","type":"text","label":"Location/Address of Loss","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Describe use of premises","type":"text","label":"Premises occupied as","options":[],"required":true,"pdf_field":""},{"help":"Explain how loss happened and entry method","type":"text","label":"Describe fully circumstances of Loss, how the entry into the premises was effected","options":[],"required":true,"pdf_field":""},{"help":"Describe signs of forced entry or exit","type":"text","label":"State the evidence of forcible entry/exit from the premises","options":[],"required":true,"pdf_field":""},{"help":"List items lost, their amounts insured and amounts claimed separately; exclude profit; specify add-on cover amounts separately","type":"table","label":"What is Lost & Extent of Loss (Attach separate sheet if more than 1 items)","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"D. General","fields":[{"help":"","type":"yes-no","label":"Has the loss or damage been reported to the Police?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"FIR number and date if reported","type":"text","label":"If yes please provide the following-: a) The FIR no. & Date","options":[],"required":false,"pdf_field":""},{"help":"Police station details","type":"text","label":"b) The Police Station name & Address","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has the Police apprehended any person?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of apprehended person","type":"text","label":"If yes, please provide details","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is there any other insurance in force providing cover for this loss or damage?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Other insurer details","type":"text","label":"If yes, please provide name of Insurer(s), policy no. and copy of Policy","options":[],"required":false,"pdf_field":""},{"help":"Fire insurance policy details","type":"text","label":"Please provide details of Fire insurance of the premises/property","options":[],"required":false,"pdf_field":""},{"help":"Fire insurance policy number","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Fire insurance end date","type":"date","label":"to","options":[],"required":false,"pdf_field":""},{"help":"Fire insurance company","type":"text","label":"Insurer","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Have you ever suffered a loss in the past?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of past losses","type":"text","label":"If yes, please provide Date, Amount of Loss and Name of Insurer","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are there any steps taken to prevent a recurrence","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Preventive measures taken","type":"text","label":"If yes, please provide details (please attach separate sheet if required)","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are the premises protected by Burglar Alarm, security system, armed guard (common or dedicated)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of security measures","type":"text","label":"If yes, please provide details of the same","options":[],"required":false,"pdf_field":""},{"help":"Guard details and duty status","type":"text","label":"If guarded by a security personnel, was the guard armed and whether on duty at the time of incident","options":[],"required":false,"pdf_field":""},{"help":"Alarm activation status","type":"text","label":"If installed with burglar alarm or a security system, was the same activated during the incident","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Was there another person, in your opinion, suspected of the theft?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Suspect details","type":"text","label":"If yes, please provide name, address & phone no.","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the property subject to a hire purchase or hypothecation agreement?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of financial institution","type":"text","label":"If yes, please provide name & address of relevant parties/financial institution","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has there been any alteration in the occupation or use of the premises since the Policy was taken up?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of changes in use","type":"text","label":"If yes, please provide details of changes/alterations","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Were the premises occupied at the time of the loss or damage?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Duration premises were unoccupied","type":"text","label":"If not, unoccupied since","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you the sole owner of the premises/property?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Other owners or interested parties","type":"text","label":"If not, please provide details of other interested. Parties","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is any part of the premises lent, let or sub-let?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of tenancy or subletting","type":"text","label":"If yes, please provide details of the same","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you responsible for repairs?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Total value of property at premises","type":"amount","label":"At the time of loss, what was the total value of all property in the premises?","options":[],"required":true,"pdf_field":""},{"help":"Subject to company consent and premium acceptance","type":"yes-no","label":"Would you like to reinstate the Sum Insured of the affected items by payment of additional premium?","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Burglary Insurance Policy (Retail)","attachments":["copy of FIR if reported","copy of other insurance policy if applicable","details of past losses if any","details of preventive measures if applicable","any separate sheets attached for additional information or items lost"],"declarations":["The form is issued without prejudice to policy terms and is not a waiver of any breach by the insured.","The insured must furnish full and accurate particulars and return the form immediately.","The insured should not make any offer or admission of liability to third parties.","Any communications received regarding the accident must be sent to the company immediately.","The insured declares all information is true and no material information is withheld, and understands claim may be refused if information is untrue or concealed."],"dropped_labels":1},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"Magma General Insurance Limited (Claims Hub), Srinilaya Cyber Spazio Suite 101, 102, Ground Floor, Road No. 2, Banjara Hills, Hyderabad, Telangana – 500034","label":"Claims Hub Address","level":null,"hours":null,"applies_to":"health","source_url":"https://www.magmainsurance.com/learn-about-claims","quote":"fe takes an unexpected turn. When that moment comes, a clear and dependable claims process makes all the difference. At Magma General Insurance, our aim is to make the process simple to understand, transparent to follow, and supportive at every step. This page explains how claims work across Health, Motor and Non‑Motor policies.\nClaim is easy at Magma General Insurance.\nRegister Claim\nHealth","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"customercare@magmainsurance.com","label":"Customer Care Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.magmainsurance.com/web/magmainsurance/claims","quote":"ma HDI General Insurance Company Limited) | All Rights Reserved\n| IRDAI Reg. No. 149 |\nwww.magmainsurance.com\n| E-mail:\ncustomercare@magmainsurance.com\n| Registered & Corporate Office: Equinox Business Park, Tower 3, Ambedkar Nagar, 2\nnd\nFloor, Unit Number 1B & 2B, LBS M","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 266 3202","label":"Claims Intimation Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.magmainsurance.com/web/magmainsurance/claims","quote":"surance Claims - Motor & Health Insurance Claim Process - Magma Insurance - Magma\nSkip to Content\nOne-Line-Hearder-Test\n1800 266 3202\nNavigation\nCustomer Service\nSenior Citizen Services\nRoad side Assistance\nAnnual Health Check-up\nPolicy Servicing assist","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/magma-general-insurance/797-burglary-insurance-policy-retail-claim-form"}